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Wellmont Health System

Organization Active NPI General Acute Care Hospital · Bristol, TN

NPI 1124058615 · NPPES record last updated Apr 16, 2024

Key facts

NPI
1124058615
Entity type
Organization (NPI type 2)
Primary specialty
General Acute Care Hospital 282N00000X
Legal business name
WELLMONT HEALTH SYSTEM
Practice address
1 Medical Park Blvd
Bristol, TN 37620-7430
Phone
(423) 844-1121
NPI assigned
Jul 3, 2006
Organization subpart
No

Authorized official

Name
Shane Edwin Hilton
Title
Evp/Cfo
Phone
(423) 302-3467

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Facilities with the same owner 40

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 40

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

Affiliated clinicians 776

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 776

Medicare Care Compare: Hospital

Listed as
Wellmont Bristol Regional Medical Center CCN 440012
Overall star rating
★★☆☆☆ 2 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in TN, VA

Hospital certification: CCN 440012

Legal name
WELLMONT HEALTH SYSTEM
Doing business as
BRISTOL REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 4, 2010
Beds
282
Ownership / control type
Hospital district or authority
Organization structure
Corporation · Non-profit
Incorporated
Jul 1, 1996 in TN
Enrollment address
1 Medical Park Blvd
Bristol, TN 37620-7430
Other Hospital Practice Location
Hospital subgroups
General, Acute care, Psychiatric

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Shane Hilton
Individual 		Corporate Officer
Evp/Cfo		 Apr 4, 2024
Corporate Director
Evp/Cfo		 Apr 4, 2024
Gregory Wilgocki
Individual 		Corporate Director
SVP		 Feb 1, 2018
W-2 Managing Employee
SVP		 Feb 1, 2018
Wellmont Health System
Organization · Johnson City, TN
Corporation 		5% Or Greater Direct Ownership Interest Jul 1, 1996 100%
Ballad Health
Organization · Johnson City, TN
Corporation, Non-profit 		5% Or Greater Indirect Ownership Interest Feb 1, 2018 100%
Marvin Eichorn
Individual 		Corporate Officer
Evp/Cao		 Feb 1, 2018
Corporate Director
Board Member		 Feb 1, 2018
Buford Deaton
Individual 		Corporate Officer
Evp/Coo		 Feb 1, 2018
Corporate Director
Board Member		 Feb 1, 2018
Alan Levine
Individual 		Corporate Officer
Ceo/President		 Feb 1, 2018
Corporate Director
Board Member		 Feb 1, 2018
Julie Bennett
Individual 		Corporate Officer
Evp/Clo		 Feb 1, 2023
Corporate Director
Board Member		 Feb 1, 2023

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hawkins County Memorial Hospital
Rogersville, TN · CCN 440032		 Hospital 5% Or Greater Indirect Ownership Interest (100%) Apr 6, 2000
Lonesome Pine Hospital
Big Stone Gap, VA · CCN 490114		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2007
Lonesome Pine Hospital Swing Bed Unit
Big Stone Gap, VA · CCN 49U114		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 19, 2007
Dickenson Community Hospital, Inc.
Clintwood, VA · CCN 491303		 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 28, 2021
Greeneville Community Hospital
Greeneville, TN · CCN 440050		 Hospital 5% Or Greater Indirect Ownership Interest (100%) Dec 8, 2016
Norton Community Rehabilitaion Unit
Norton, VA · CCN 49T114		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2007
Dickenson Community Hospital Psychiatric Unit
Clintwood, VA · CCN 49M303		 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 28, 2021
Norton Community Hospital SNF Unit
Norton, VA · CCN 495374		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Aug 1, 2007
Apr 1, 2004
Bhrhc Dickenson
Clintwood, VA · CCN 493463		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 28, 2021

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031223000853 TN Part B Supplier - Clinic/Group Practice 2567360704 Receives reassigned benefits from 4 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bristol, TN; Kingsport, TN; Sneedville, TN
O20040608000164 VA Part a Provider - Hospital 2567360704 Practice locations: Bristol, TN
O20180125002244 TN Part B Supplier - Intensive Cardiac Rehabilitation 2567360704 Practice locations: Bristol, TN

National Provider Directory

Tax ID family
Wllmnt Bristol PK Blvd (25 organizations share this tax ID)

Locations

1230 Volunteer Pkwy
Bristol, TN 37620
Phone (423) 764-2566

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Yes

Addresses

Primary practice location

1 Medical Park Blvd
Bristol, TN 37620-7430

Mailing address

311 Princeton Rd Ste 1
Johnson City, TN 37601-2026
Phone (423) 844-1121

Other identifiers

IdentifierTypeStateIssuer
6530115OtherTNAETNA
004400127MedicaidVA
1377051OtherTNUMWA
240867OtherVAANTHEM
A3762106MedicaidTN
1000319OtherTNTN BLUE CROSS
10260BMedicaidSC
A3762106OtherTNUHC RIVER VALLEY
100020309MedicaidTN
033361400OtherTNBLACK LUNG
0440012MedicaidTN
166592403OtherTNPOSTAL WORKERS DEPT LAB

Other names

  • BRISTOL REGIONAL MEDICAL CENTER Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://67.32.31.88:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other WELLMONT HEALTH SYSTEM

Other providers in Bristol, TN

All providers in Bristol, TN · General Acute Care Hospital in Tennessee

Sources for this page

Verify at the official NPI Registry.